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J Neurol Surg A Cent Eur Neurosurg 2014; 75(06): 462-466
DOI: 10.1055/s-0033-1361836
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Tarlov Cysts: Endoscope-Assisted Obliteration of the Communication with the Spinal Subarachnoid Space

Juan Mezzadri
1   Department of Neurosurgery, Hospital de Clínicas, Buenos Aires, Argentina
,
Santiago Gonzalez Abbati
1   Department of Neurosurgery, Hospital de Clínicas, Buenos Aires, Argentina
,
Pablo Jalon
1   Department of Neurosurgery, Hospital de Clínicas, Buenos Aires, Argentina
› Author Affiliations
Further Information

Publication History

06 January 2013

28 June 2013

Publication Date:
28 March 2014 (online)

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Abstract

Background and Objective The physiopathology of Tarlov or perineural cyst (PC) symptoms is unknown, but probably its filling and distention with spinal cerebrospinal fluid makes them symptomatic. The objective of this study is to describe the endoscope-assisted obliteration of the communication between PCs and the spinal subarachnoid space (SSS).

Patients and Methods From 2007 to 2011, four male and two female patients (median age: 45 years) with PCs were treated. They complained of lumbar, sciatic, and/or perineal pain. Physical examination was normal. The diagnosis was made by magnetic resonance imaging (MRI). All the cysts were located in the midline between S1 and S3. An endoscope-assisted obliteration between PC and SSS was performed. The outcome was evaluated clinically with the Odom scale and radiologically with an MRI.

Results After a median follow-up of 25.83 months, the outcome was excellent (four cases), good (one case), and poor (one case). There were no complications. The postoperative MRI showed size and signal intensity changes in all PCs reflecting their exclusion from the SSS.

Conclusions The endoscope-assisted obliteration of the communication between PCs and the SSS is a simple technique that rendered excellent to good results in 83% of the cases.

Keywords

Tarlov cysts - perineural cysts - spine endoscopy
 

  • References

  • 1 Tarlov IM. Cysts (perineurial) of the sacral roots; another cause, removable, of sciatic pain. J Am Med Assoc 1948; 138 (10) 740-744
    CrossrefPubMedGoogle Scholar
  • 2 Acosta Jr FL, Quiñones-Hinojosa A, Schmidt MH, Weinstein PR. Diagnosis and management of sacral Tarlov cysts. Case report and review of the literature. Neurosurg Focus 2003; 15 (2) E15
    PubMedGoogle Scholar
  • 3 De Sá MC, D'Angelo CT, Da Ros Malacarne G, Neto P, Pagura J. Tarlov's cyst: definition, etiopathogenesis, propaedeutic and treatment. [in Portuguese]. Acta Med Port 2008; 21 (2) 171-178
    PubMedGoogle Scholar
  • 4 Voyadzis JM, Henderson FC. Tarlov cysts. In: Benzel EC, , ed. Spine Surgery: Techniques, Complications Avoidance, and Management. Philadelphia, PA: Elsevier; 2005: 1124-1130
    Google Scholar
  • 5 Langdown AJ, Grundy JR, Birch NC. The clinical relevance of Tarlov cysts. J Spinal Disord Tech 2005; 18 (1) 29-33
    CrossrefPubMedGoogle Scholar
  • 6 Odom GL, Finney W, Woodhall B. Cervical disc lesions. JAMA 1958; 166: 23-28
    CrossrefPubMedGoogle Scholar
  • 7 Nabors MW, Pait TG, Byrd EB , et al. Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 1988; 68 (3) 366-377
    CrossrefPubMedGoogle Scholar
  • 8 Tarlov IM. Spinal perineurial and meningeal cysts. J Neurol Neurosurg Psychiatry 1970; 33 (6) 833-843
    CrossrefPubMedGoogle Scholar
  • 9 Ishii K, Yuzurihara M, Asamoto S, Doi H, Kubota M. A huge presacral Tarlov cyst. Case report. J Neurosurg Spine 2007; 7 (2) 259-263
    CrossrefPubMedGoogle Scholar
  • 10 H'ng MWC, Wanigasiri UIDK, Ong CL. Perineural (Tarlov) cysts mimicking adnexal masses: a report of three cases. Ultrasound Obstet Gynecol 2009; 34 (2) 230-233
    PubMedGoogle Scholar
  • 11 Tarlov IM. Perineural cysts of the spinal nerve roots. Arch Neurol Psychiatry 1938; 40: 1067-1074
    CrossrefPubMedGoogle Scholar
  • 12 Peh WC, Evans NS. Tarlov cysts—another cause of sacral insufficiency fractures?. Clin Radiol 1992; 46 (5) 329-330
    CrossrefPubMedGoogle Scholar
  • 13 Duja CM, Berna C, Kremer S, Géronimus C, Kopferschmitt J, Bilbault P. Confusion after spine injury: cerebral fat embolism after traumatic rupture of a Tarlov cyst: case report. BMC Emerg Med 2010; 10: 18
    CrossrefPubMedGoogle Scholar
  • 14 Ruibal Moldes M, Sánchez Rodríguez-Losada J, López García D, Casas Agudo V, Janeiro País JM, González Martín M. Tarlov cyst and symptomatic bladder disfunction. [in Spanish]. Actas Urol Esp 2008; 32 (10) 1035-1036
    CrossrefPubMedGoogle Scholar
  • 15 Singh PK, Singh VK, Azam A, Gupta S. Tarlov cyst and infertility. J Spinal Cord Med 2009; 32 (2) 191-197
    CrossrefPubMedGoogle Scholar
  • 16 Mezzadri J. Lumbar and cervical pain of discal origin. In: Micheli F, et al, eds. Tratado de Neurología Clínica [in Spanish]. Buenos Aires, Argentina: Editorial Médica Panamericana; 2002: 185-208
    Google Scholar
  • 17 Avellanet M, Sáenz A, Mirapeix RM , et al. Tarlov cysts: three symptomatic cases. [in Spanish]. Rehabilitación (Madr) 2004; 38: 250-253
    CrossrefPubMedGoogle Scholar
  • 18 Caspar W, Papavero L, Nabhan A, Loew C, Ahlhelm F. Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases. Surg Neurol 2003; 59 (2) 101-105 ; discussion 105–106
    CrossrefPubMedGoogle Scholar
  • 19 Mummaneni PV, Pitts LH, McCormack BM, Corroo JM, Weinstein PR. Microsurgical treatment of symptomatic sacral Tarlov cysts. Neurosurgery 2000; 47 (1) 74-78 ; discussion 78–79
    CrossrefPubMedGoogle Scholar
  • 20 Park HJ, Kim IS, Lee SW, Son BC. Two cases of symptomatic perineural cysts (Tarlov cysts) in one family: a case report. J Korean Neurosurg Soc 2008; 44 (3) 174-177
    CrossrefPubMedGoogle Scholar
  • 21 Patel MR, Louie W, Rachlin J. Percutaneous fibrin glue therapy of meningeal cysts of the sacral spine. AJR Am J Roentgenol 1997; 168 (2) 367-370
    CrossrefPubMedGoogle Scholar
  • 22 Cure GC, Fonnegra Caballero A, Diez JC , et al. Lumboperitoneal shunt for treatment of symptomatic lumbar Tarlov cysts. [in Spanish]. Rev Chil Neurocirugía 2009; 33: 34-38
    PubMedGoogle Scholar
  • 23 Karabatsou K, Quigley G, Buxton N, Foy P, Mallucci C. Lumboperitoneal shunts: are the complications acceptable?. Acta Neurochir (Wien) 2004; 146 (11) 1193-1197
    CrossrefPubMedGoogle Scholar
  • 24 Wang MY, Levi AD, Green BA. Intradural spinal arachnoid cysts in adults. Surg Neurol 2003; 60 (1) 49-55 ; discussion 55–56
    CrossrefPubMedGoogle Scholar